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Thursday, 27 June 2013

Junior doctors squeezed by working conditions

How do junior doctors experience current working conditions? Pressures on public sector spending in many countries have put the squeeze on their health services, and this strata of the workforce - already renowned as being under pressure - seem to be feeling extra strain. This is the suggestion of a recent study that investigates the experiences of twenty junior doctors in the Irish medical system.

The participants provided their experiences through qualitative interviews with the researchers, working from the ground up to collect their perspectives and identify the common themes that emerged. Those interviewed were just about to transition into roles as clinical tutors, a hybrid role that involves both clinical practice and academic teaching of medical students. The shape of these individuals' careers to date mirrors what is typical for junior doctors: working as temporary employees on a 3-, 6-, or 12-month basis.

The first theme that emerged was one of staffing shortages. The interviewees saw shortages as contributing to longer hospital stays for patients, whose problems were not getting detected as quickly. In addition, they complained that lean workforces often meant that a senior perspective was not available as much as they would like, which would normally provide an expert viewpoint to benefit both diagnosis and the junior doctor's understanding. Because of staffing shortages, there were also fewer opportunities to take leave for training. As one interviewee remarked, 'Training isn’t the best. It’s very much ‘see one, do one, teach one’'

The next theme was how unrealistic workloads had become. Some of this was due to wider societal factors: as healthcare developments both extend lifespan and increase detection of multiple conditions, patients' problems can be more acute and involve multimorbidity (multiple diagnoses), making treatment a more complex matter. But workload issues also related to the first issue of shortages, which contributed to long hours, interrupted breaks, and pressure to complete tasks quickly: 'I have a sense of dissatisfaction with being able to give each patient on a round just 90 seconds on average.' Another interviewee noted the personal consequences of this overworking: 'When you do something wrong, not out of malice or incompetence, because you’re too tired, then you have to live with it.'

As well as these themes, interviewees reported issues with unpredictability of their work. Their schedules as well as lengthy (80-90 hour weeks) were subject to change, leading one to comment 'It is the not knowing. I have missed christenings and birthdays and let people down'. The high workloads also forced the work-home divide to become porous, with paperwork often taken home to be completed outside of 'work'. And within the hospital, cuts meant doctors could not rely on having the needed equipment to hand, but at times had to devote time to hunting it down elsewhere.

Despite all these challenges, respondents tended to give less attention to how the conditions affected their own wellbeing, framing issues more in terms of problems for patients or the smooth running of the system. The authors reflect that this tendency to soldier on may be because doctors see their role as evaluating stress and illness in others, and so are reluctant to see themselves as the ones who may at times be in need. Previous research also suggests that doctors are reluctant to seek health care from other doctors due to embarrassment, especially for less-defined illnesses such as stress. This is despite the fact that doctors display higher levels of stress than those found in the general population.

'The challenges currently faced by junior doctors in Ireland identified within this study are likely to be illustrative of problems faced by junior doctors in many countries where government spending is decreasing and deficits are rising.' Overextension of this layer of the medical profession is bound to have consequences for patients - US figures estimate medical error contributes to 180-195,000 patient deaths annually - and also, whether they like to admit it, to the wellbeing of the junior doctors on whose shoulders so much rests.